Transcript West Nile Virus Surveillance Training

DoD West Nile Virus Surveillance Program
Entomological Value, Implications, &
Lessons Learned
Ben Pagac, Army Center for Health Promotion & Preventive Medicine, Fort Meade, MD
Most rapidly-spreading arboviral
disease ever documented
1999
2000
2001
2002
2003
2004
2005
2006
WNV Human Disease*
Year
1999
2000
2001
2002
2003
2004
2005
2006
Total
Rank
7
8
6
3
1
5
4
2
-
Cases
62
21
66
4,156
9,862
2,539
3,000
4,189
23,895
Fatalities
7
2
9
284
264
100
119
149
934
Hotest States
NY
NY, NJ, CT
NY, NJ, FL
IL, MI, OH
CO. NE, SD
CA, AZ, CO
CA, IL, SD
ID, CO, CA
*Military-associated: 2006 - 7AD; 2004 - 3 (1 AD, 2 dep/ret)
DoD Installations/facilities
Since North American WNV Onset
Key DoD Surveillance Objectives
1. Rapid, open communication
2. Blend multi-agency efforts
3. Early detection
4. Implement PREVENTIVE vector management
5. Implement measured response planning based on
surveillance findings
6. Reduce the human disease threat
Field, Lab, Data, Response, Collaboration, Readiness
Field….
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Trapping – type, habitat, frequency
Specimen ID – tools, keys, guides
Adjusted duties – based on resources
(mosquito and dead bird collection)
Specimen handling – cold-chain, shipping
Training - on site & regional, with realistic expectations
That’s so…
yesterday
Lab….
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Mission expansion – Regional lab expansion
Specimen processing – volume, tracking, cold-chain
ID verification – spot check, reliability feedback (comm. loop)
Testing – RT PCR
Turn-around: Supplies for field
Turn-around: Results (mosquito trap numbers…immediate!)
Average intervals:
2004 (73k fm / 10k pools) 10d post-collection / 6d post-receipt
2006 (6.5k fm / 890 pools) 9d post-collection / 5d post-receipt
CHPPM Labs – Mosquito Data Flow
Data Reporting…
Immediate Notification of +Pools – PHONCON, FAX, EXSUM
To: FE, PVNTMED, State Health Depts, MEDCOM Reps
Weekly Report Via E-Mail – w/ Bird. Human, Veterinary data
To: FE, PVNTMED, DOD GEIS, CDC, interested parties
Web Database- since 2005
To: all people – link also provided from e-mail
Monthly Reports & web database
To: State Health Depts.
National Database - ARBONET
To: CDC
Triennial DoD Meetings-Summary
To: Armed Forces Pest Management Board
Special Projects – Threat/GIS Mapping/Modeling
To: Academic/Military Institutions
Response…..
Response…..
VecTest
Kit
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Is abbreviated surveillance worth doing?
In 2006 guidance for 13 sensitive DC sites; 2 - 4 gravid traps, 1 night/week
Year
Trap
Nights
Ave.
Trap
Nights
Trap
Index
# pos.
pools
MIR
(X1000)
# positive
installations
Range; #
positive
pools per
installation
2005
623
50
12.6
15
2.2
4/13
0-8
2006
534*
41
11
27
4.0
8/13
0-6
*14% reduction
Trend: positive pools tended to show up when installation TIs exceed 10.
TIs and positive pools - tangible basis for triggering systematic intervention
Does intervention have an impact?
Trap indices at army-supported DC area installations during week of
first WNv-positive pool detection and two-weeks after response was initiated.
Collaboration….
Examples:
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Intra-DOD – Military Services, DEH, MED, VET,
CHPPM, GEIS, WRAIR, USAMRIID, AFIP
Inter-agency/institution – NPS, USGS, CDC,
States, COG, Academia
Current Mosquito Trapping Sites
( Each site = 1 to 20 traps)
NPS
Nat. Zoo
Army
Navy
Air Force
Arling/Alex.
DC
N
Readiness….
West Nile Virus: approximate geographic range
Conclusions
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Military Med, Vet, and Engineering resources quickly adapted to the establishment
of a comprehensive National surveillance and response program for a threat of
unknown magnitude
Vocational boundaries were sometimes willingly stretched to accomplish mission
Military efforts blended with, bolstered, and sometimes were the sole source of
National epidemiologic information on the WNV threat
Health threat response measures were data driven
Value of data was maximized by broad & rapid distribution
Trap indices can be predictive of viral activity
Field-expedient wicking assays work
Targeted interventions work
2006 – Lean DoD Surveillance at sensitive Military (DC) sites proved valid &
valuable; to continue in 2007
Principles & experience gained are being applied OCONUS
Elevated diagnostic capabilities with quick turn-around, large sample capacity,
great accuracy, appropriate equipment, and adaptability are poised to address
other potential threats
Enhanced domestic military field vector surveillance experience, capability, and
infrastructure are in place to tackle future potential threats (natural or malicious)
ACKNOWLEDGEMENTS:
DOD Global Emerging Infectious Disease System (CDR Clara Witt)
Army Proponency Office for Preventive Medicine (LTC David West)
Centers for Disease Control & Prevention (Drs. D. Gubler, C. Moore, R. Wirtz, R. Nasci)
US Geological Survey Nat. Wildlife Hlth. Ctr. (Drs. R. McLean, L. Glaser, E. Saito, G.
McGlaughlin)
NY State Health Department (Dr. Dennis White)
State & Municipal Health Departments
Collaborating Universities
DC Department of Health (Dr. Peggy Keller, Ms. J. Hinson)
US National Park Service (Ms. Jil Sweringen)
Smithsonian Institution National Zoological Park (Drs. R. Yates, R. Montalli)
Walter Reed Army Institute of Research (LTC J. Ryan)
Army/Navy/Air Force Preventive Medicine Personnel
Army/Navy/Air Force Public Works, Pest Management Personnel
Army Medical Research Institute for Infectious Diseases (MAJ J. Blow, Dr. Michael Turell)
Army Veterinary Clinics (MAJ Felicia Langel)
Army Veterinary Command Food Analysis and Diagnostic Lab
Air Force Institute of Env., Safety, Occ. Health Risk Analysis (Dr. Chad McHugh)
Navy Disease Vector Ecology Center (CDR David Claborn)
Army CHPPM–N,S,W (E. Stanwix, D. Kuhr, W. Irwin, J. Harrison, M. Miller, S. Spring)
Army CHPPM-N,S,W Survey Officers and Technicians
Armed Forces Retirement Home (T. Bechtol, Andy Dietz)